13090197 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 906 SEPTEMBER DR CONTRACTOR:AAA FURNACE&AIR PERMIT NO: 13090197
CONDITIONING
OWNER'S NAME: FIELDER ROSE L 1712 STONE AVE DATE ISSUED:09/25/2013
OWNER'S PHONE: SAN JOSE,CA 95125 PHONE NO:(408)293-4717
❑ LICENSED CONTRACTOR'S DECLARATION
�7 BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class C! Z0 Li,.# (0 e /-//�/'
r� MECH r— RESIDENTIAL f— COMMERCIAL�
Contractor 6 A 6 1—V r uA omate 2
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REMOVE AND REPLACE 40 GAL WATER HEATER
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following.two declarations:
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
ormance of the work for which this permit is issued. Sq.Ft Floor Area: Valuation:$1599
have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. APN Number:36214010.00 Occupancy Type:
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR
indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION.
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands`andwill'comply
with all no - t source regul ions er the Cupertino Municipal-Cod6,Section Issued by:z�^ l �� Date:
9.18 � -
Signature Date*2<
RE-ROOFS:
❑ OWNER-BUILDER DECLARATION All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
I hereby affirm that I am exempt from the Contractor's License Law for one of inspection.
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, Signature of Applicant: Date:
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
construct the project(Sec.7044,Business&Professions Code).
I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE
declarations: I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
Compensation,as provided for by Section 3700 of the Labor Code,for the compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material.
1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air
Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will
permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
SafetyC d ,Sections 25505,25533,and 25534.
I certify that in the performance of the work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's Owner or t r d agent:
Compensation laws of California. If,after making this certificate of exemptio ,I `�"'�— Date:
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of work's
APPLICANT CERTIFICATION for which this permit is issued(Sec.3097,Civ C.)
I certify that I have read this application and state that the above information is Lender's Name
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this.city to enter Lender's Address
upon the above mentioned property for inspection purposes.(We)agree to save
indemnify and keep harmless the City of Cupertino against liabilities,judgments, ARCHITECT'S DECLARATION
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply I understand my plans shall be used as public records.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. Licensed Professional
Signature Date
C� 0
GeN:ERAL PERMIT APPLICATION ME p
COMMUNITY DEVELOPMENT DEPARTMENT-- V.1LDING DIVISION
10300 TORRE AVENUE ' CUPERTINO; CA 95014-3255
(408)777-3228 • FAX(408)777-3333•building(Mcupertino.org MISC
C U R ERT1`44
r
PLUMBING ❑MECHANICAL ELECTRICAL n❑MIISCELLANEOUS/
PROJECT ADDRESS qO� S�'.rPrv,�/�o y 1 Y�(�� Af'N-k
OWNER NAME PH NE ` &00;/) � E/hL1B {{
STZZTADDRESS�t/yl/nr�•,it �4e4'�YI'er Q(• CTT* ST �` � �( FAX
coNTACT NAME t 101LJ G� CJS/' PHONE V C/t I A4 FAX
STREBT ADDRESS CITY,STATE, ZIP FAX
• ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CTOR ❑CONTRACTOR AGENT ❑ ARCHTTECT ❑ENGINEER ❑ DEVELOPER Cl TENANT
CONTRACTOR NAME LICENSE NUMBER 7UTETgfC-2-0
BUS.LIC 1
COWANY NAME Fu t't'1 GI Of, E•MAlL ' FAX4
��2��
STREET ADDRESS C '2vT`y / �• #-I ST
CAW Ott 2� 'MN'4C%-29-3-4 1/
ACOTECIYENOI]N=NAlva
LICENSE NUtABER BUS.LIC f
COMPANYNAME E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF ,;;—SFD or Duplex p Multi-Family PROJECT IN WILDLAND PROJECT IN
STRUCTURE: Cl Commercial URBAN INTERPACE AREA ❑ Yes 6 No FLOOD ZONE ❑ Yes iNO
DESCPJMON of WORK rexYrch.0 000 t GSC(/ e!y t () <<�,A vl ol-e' N-ct-tlw
TOTAL VALUATI6N: BC16(,U0
97my signature below,I certify to each o the folloUct. 1
the property owner or authorized agent to act an the property owner's behalf. I have read this
application and the information I have pr ided is cve read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinancesandstatelawsrelatin to buil ing co thorize representatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: - Date:
UP EN1E AL INFORMATION REQUaED
bffPi' ucApp2011.doc revised 03/16/11
CITY OF CUPERTINO
FEE ESTIMATOR—BUILDING DIVISION
ADDRESS: 906 September Drive DATE: 09/25/2013 REVIEWED BY: Sean
APN: BP#: e 0 *VALUATION: 1$1,599
xPERMIT TYPE: Plumbing Permit PLAN CHECK TYPE: Alteration/Addition/ Repair
PRIMARY SFD or Du lex PENTAMATION PRWHEATR
USE: p PERMIT TYPE:
WORK Remove and replace 40 gallon water heater.
SCOPE
APPLIANCE/EQUIP TYPE FEE ID QTY UNITS BP FEES
Water Heater 1PRWHEATR 1 # $28
TOTALS: ' $28 00
1P
llech. Flan Check Plumb.Plan Check 0.0 hrs $0.00 Elec.Plan(.heck
V1ac:h. Permit Fee: Plumb.Permit Fee: IPPERMIT Elec. Permit I ee:
Other iVech.Insp. Other Plumb Insp. 0.0 hrs $47.00 Other Elec.Insp.
El
111ech, Insp. Fee: Plurnh. Insp.)-ee: Elce.Insp.Fce:
NOTE:This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School
District,eta). Theseees are based on the prelimina information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS
Plan Check Fee:
Suppl. FC Fee
PME Plan Check: $0.00
Permit.Fee:
Suppl. Insp Fee
PME Unit Fee: $28.00
PME Permit Fee: $47.00
(,onstruction Tax:
Administrative Fee: 1ADAffN $44.00
Work Without Permit? ®Yes (E) No $0.00
Aelvanced Planning Tees:
Travel Documentation Fee: 1TRAVDOC $47.00
Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: 1BCBSC $1.00
$167.50 $0.00TOTAE $167.50
Revised: 08/01/2013
L:,U�� 'f—t1rVGr
CF-1R-ALT
Prescriptive Certificate of-C:om liance: Residential pa e 4 of 5)
Residential,alterations Climate Zone# #of Stories
Project Name,
i
HVAC SYSTEMS-HEATING Configuration
MinimumDucrulatiipi•rig Central,Split,
Heating Equipment Efficiency Distribution
Insulation Thermostat Space,Package or H dronic)
T e and Ca aci "M ( \FUE or HSPF T e and Location R-Value
1.Indicate Heating Type(Cent.-al Furnace,.Wall Furnace. Hear pump, Boiler. Electric Resistance, etc.)
.Electric resistance heating is allowed only in Component Package C. or except where electric heating is supplemental(i.e.,if total capacity
�• < 2 KWor 7,000 Btu/hr electric heating is controlled by a rime-limiting device not exceeding 30 minutes). See§151(b)3 exception.
3.Refer to the HERS Verification section on Page 4 of the CF-IR-ALT Form Jor additional regeru-ements and check applicable boxes.
4. Indicate Type or Location(Duets, Hvdronic in Floor, Radiators,etc.)
HVAC SYSTEMS-COOLING
Minimum Configuration
Efficiency Duct or Piping
Insulation Thermostat (Central,Split,
Cooling Equipment (SEEP/EER or Distribution T e Space,Packa a or H dronic
Type and Ca acit "- COP) Type and Location R-Value
I. Indicate Cooling Type(A/C. Heat pump, Evap. Cooling, etc)
2. Refer to rhe HERS Verification section on Page 4 of rhe CF-IR-ALT Form for additional requirements and check applicable bores.
3. Indicate Type or Location (Ducts,H dronic in Floor, Radiators, etc.)
WATER HEATING
and hydropic space heating. Individual dwelling DNW heaters
List water heaters and boilers for both domestic hot water(DHW)heaters must b.
gas or propane fired, and may not exceed 50 gallons. Hot water pipe insulation from the DHW heater to the kitchens)and on all underground
hot tearer pipes is required in all com.onent packages in all climate zones. External Tank
Tank Energy Factor or insulation
Water Heater Type/Fuel Distribution Type
Number In
T er (Standard, Recirculating, system Capacity( al) Thermal Efficiency R-Value
-i�( pt Yl�ark
1. indicate Type(Storage Gas, Heat Pump, instantaneous. etc.)
2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of§150(n). The Prescriptive requiremenu db
not allow the installation of a recirculating water heating system Jor single dwelling units.
3. The external water heating tank and pipes shall be insulated to meet the requirements of§150 ).
SPECIAL FEA.TURES The enforcement agency should pay special attention to the Special Features specified in this checklist below-
These items may re afire written iustification and documentation ands ecia!yeti nation.
NEW ROOF ASSEMBLY-Radiant Barrier
The radiant barrier requirement of, 151( 2 does not apply to roof alterations.
Slab Edge(Perimeter)Insulation El YES O R7 insulation is required.
YES: in Climate.Zone 16 in Component Packages D,
Heated Slab Insulation O YES C] NO
YES:Slab edge insulation required for all heated.slabs in all Climate Zones. See details in Table 118-A of the standards.
Raised Slab Insulation U YES C3 NO
YES:In Climate Zones I,2; 11, 13, 14'.& 16,R4 insulation is,required; in Climate Zones G2,& 15,:R 4 is required under comonentPa
Thermal Mass
To obtain Compliance Credit for the installation of therrtral mass is'se.theI?erformance A roach.
HERS Provider:
Registration Number:
Registration Dare/Time: August 10
2008 Residential Compliance Forms